Screening for Abdominal Injury Prior to Emergent Extra-Abdominal Trauma Surgery: A Prospective Study

Abstract

To prospectively evaluate the necessity of abdominal screening with computed tomography (CT) in awake and alert blunt trauma patients that require emergent extra-abdominal trauma surgery. All blunt trauma patients admitted to a Level I trauma center that required emergent extra-abdominal trauma surgery were entered in a prospective study during the period from April 2001 to June 2003. Awake and alert blunt trauma patients (Glasgow Coma Scale [GCS] score > or =14) with a normal abdominal physical examination requiring extra-abdominal emergent surgery were entered in the study. All patients entered were greater than 14 years of age, hemodynamically stable, and underwent further abdominal evaluation with CT scan following the decision for extra-abdominal surgical intervention. Emergent extra-abdominal trauma surgery occurred within 8 hours of emergency room admission. The results of all diagnostic studies, hemodynamic values, mechanism of injury indications for extra-abdominal surgical intervention and outcome were analyzed. One hundred sixty-two patients were entered in the study with average age of 32 years (range: 14-81). The most common mechanism of injury was motor vehicle crash (76%). One hundred forty-three (88%) patients presented with GCS scores of 15, and 19 (12%) patients presented with GCS scores of 14. The majority of extra-abdominal emergent surgical procedures were orthopedic (88%). Two (1.2%) intra-peritoneal injuries were diagnosed in the study population. One of the injuries was a stable Grade 1 splenic injury and the other was a small bowel mesenteric hematoma. Neither of the 2 abdominal missed injury required blood transfusion or surgical intervention. Before emergent extra-abdominal trauma surgery, abdominal evaluation with physical examination is sufficient to identify surgically significant abdominal injury in the awake and alert blunt trauma patient. Abdominal screening with computed tomography does not impact patient outcome.